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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For management of the afferent loop syndrome, surgical revision such as jejunojejunostomy or Roux-en-Y conversion is the established procedure. Percutaneous transhepatic catheter drainage was used as a method of palliative treatment of the obstructed afferent loop in a patient with extensive mesenteric and peritoneal dissemination of gastric cancer. There were no procedural-related complications, but severe bacterial cholangitis and septicemia occurred later. Our limited experience indicates that this procedure may be risky, and that an additional drainage catheter of the bile duct may be needed when biliary stasis is present.
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PMID:Septic shock after percutaneous transhepatic drainage of obstructed afferent loop: case report. 247 3

Our experience with patients who underwent orthotopic liver transplantation for sclerosing cholangitis at the University of Pittsburgh Health Center between March 1980 and March 1988 is reported here. Ten patients had an associated cholangiocarcinoma. Six of these patients died of recurrent, disseminated cancer, usually before one year. One patient died of sepsis, while three are alive and apparently free of tumor four months to almost two years later. Pre-operative identification of a possible cholangiocarcinoma and complete resection are of crucial importance. Adjuvant therapy, especially pre-transplant radiation with a prophylactic purpose is still being evaluated.
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PMID:Cholangiocarcinoma in sclerosing cholangitis. The role of liver transplantation. 254 Jan 7

Cholangitis is the most common cause of sepsis in patients with obstructing carcinomas of the biliary tree. Catheter and stent placement may relieve or exacerbate the septic course. Transhepatic stent placement produced a cholangioportal fistula and hemobilia in a patient with cholangiocarcinoma. The described technique of retrograde operative decompression and clot evacuation may be used in patients in whom portal dissection is hazardous or in whom preservation of an existing cholangiojejunostomy in the portal region is desired.
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PMID:Cholangitis, hemobilia, and cholangiocarcinoma. Management of a fistula between an obstructed right hepatic duct and the portal vein. 254 56

105 patients with acute calculous cholangitis who did not respond to conservative management underwent urgent endoscopic drainage of the biliary system at a mean of 1.5 days after admission. Treatment was successful in 102 (97%) patients. 3 of the patients in whom drainage was not successful underwent emergency surgery, with 1 death. 3 patients died of uncontrolled sepsis despite successful endoscopic drainage. 1 patient died of a stroke. The overall mortality was 4.7%. Among those in shock 2 out of 4 drained after 72 h died, compared with 3 out of 38 drained before 72 h. There were no deaths in the group without shock irrespective of the timing of drainage.
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PMID:Urgent endoscopic drainage for acute suppurative cholangitis. 256 34

Imipenem/cilastatin sodium (IMP/CS) was administered to patients with severe infections complicated by hematological disorders and solid tumors to assess its efficacy and safety. Primary diseases in this series of 76 cases included 37 cases of hematological disorders (acute leukemia in 25 cases, malignant lymphoma in 7 cases, aplastic anemia in 3 cases and 2 other diseases) and 38 cases of solid tumors (lung cancer in 7 cases, gastric cancer in 11 cases, esophageal cancer in 6 cases, pancreatic cancer in 3 cases, bile duct cancer in 4 cases, hepatocellular cancer in 3 cases, and 4 other diseases). Following results were obtained. 1. Types of infection in hematological diseases were sepsis in 5 cases, suspected sepsis in 24 cases, pneumonia in 5 cases and 3 others. The efficacy rates were 100% in sepsis, 62.5% in suspected sepsis, 80% in pneumonia and 73% in all cases. 2. Types of infection in solid tumors were sepsis in 2 cases, suspected sepsis in 13 cases, pneumonia in 10 cases, cholecystitis in 2 cases, cholangitis in 5 cases, liver abscess in 2 cases, and 4 others. The efficacy rates were 50% in sepsis, 69.2% in suspected sepsis, 80% in pneumonia, and 71.1% in all cases. 3. IPM/CS was administered in single use in 66 cases and in combination with other antibiotics in 9 cases. The efficacy rate in the single use was 72.7% and that in the combination use was 66.7%. 4. The efficacy rate in 35 cases of first use was 71.4% and that in 40 cases of second use was 72.5%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical evaluation of imipenem/cilastatin sodium against severe infections complicated with hematological disorders and solid tumors]. 261 13

Although the first Aeromonas strain was described by Zimmermann as early as in 1890, it took 60 years until Caselitz established human pathogenicity of strains then called "Vibrio jamaicensis". Since then, and especially in the last 10 years, there have been increasing numbers of reports on different infections caused by members of the genus Aeromonas. These include sepsis; meningitis; cellulitis; necrotizing fasciitis; ecthyma gangrenosum; pneumonia; peritonitis; conjunctivitis; corneal ulcer; endophthalmitis; osteomyelitis; suppurative arthritis; myositis; subphrenic abscess; liver abscess; cholecystitis and/or ascending cholangitis; urinary tract infection; endocarditis; ear, nose, and throat infections; balanitis; etc. The role of Aeromonas in gastrointestinal disease is very controversial. Increasing epidemiological data suggest that these organisms play a major role in enteric infections, but so far enteropathogenicity has not been demonstrable in experiments where volunteers were given high numbers of Aeromonas possessing different virulence factors. Virulence factors include hemolysin(s), enterotoxin(s), hemagglutinins, invasivity, and others; but these are not found more frequently in strains isolated from patients with diarrhea than from healthy controls. Whether there is a correlation between species and disease remains to be elucidated and requires more information about the taxonomy of this genus.
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PMID:Aeromonas as a human pathogen. 264 16

Endoscopic sphincterotomy is the procedure of choice for choledocholithiasis in patients who have had a cholecystectomy. The bile duct is cleared of stones in about 80 to 90 percent of patients. Available data, largely retrospective, suggest that surgery and endoscopic sphincterotomy are about equal with respect to removal of stones, morbidity, and mortality. Certain technical problems are discussed, including inability to insert the papillotome, the large stone, and problems relating to anatomy such as peripapillary diverticulum and prior gastrectomy. The treatment of patients with bile duct stones who have not had a cholecystectomy, with and without cholelithiasis, is controversial. Endoscopic sphincterotomy without subsequent cholecystectomy is adequate treatment for the majority of patients who are unfit for surgery, even if there are stones in the gallbladder, provided they are asymptomatic after endoscopic removal of stones from the bile ducts. Endoscopic sphincterotomy has been performed in the treatment of gallstone-induced pancreatitis, acute obstructive cholangitis, and sump syndrome. The complication rate for endoscopic sphincterotomy ranges from 6.5 to 8.7 percent, with a mortality rate of 0 to 1.3 percent. The most common serious complications are perforation, hemorrhage, acute pancreatitis, and sepsis.
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PMID:Endoscopic management of bile duct stones. 267 45

The diagnostic accuracy of ultrasonography (US) was evaluated in delineating the site and cause of biliary obstruction in 59 patients of surgical obstructive jaundice (SOJ). A final analysis of the ultrasonographic data was carried out in 42 patients on whom laparotomy or endoscopic papillotomy with removal of common bile duct stones, confirmed the diagnosis. Evaluation of the role of second investigation following ultrasound in 28 patients (side-viewing endoscopy in 13, ERCP in 12 and PTC in 3) was also done to determine whether they provide any additional information over ultrasonography in delineating the exact level and etiology of biliary obstruction. US was done by the clinician who interpreted the findings in conjunction with the clinical profile of the patient. US correctly diagnosed SOJ in all 42 patients. In 26 of the 28 patients with distal CBD block (specificity 87.5%; sensitivity 100%) and in 14 out of 16 patients with proximal CBD block (specificity 100%; sensitivity 87.5%) US provided and accurate diagnosis of the site of obstruction. US was correct in diagnosing a malignant etiology in 26 out of 27 malignant cases whereas it accurately indentified the benign nature of biliary obstruction in 14 of the 15 patients of SOJ due to benign obstruction (specificity and sensitivity range 93.3% to 96.3%). A second investigation could correctly change the etiology and site of biliary obstruction in only 5 patients (17.9%) whereas in the remaining 23 patients (82.1%) it did not add any additional information over the US findings. Six out of fifteen patients (40%) who underwent cholangiography had cholangitis and in one severe septicemia led to death.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Accuracy of abdominal ultrasonography and the role of a second investigation in surgical obstructive jaundice. 268 Jul 44

Twenty patients with focal malignant obstruction of the major bile ducts (6 cholangiocarcinoma, 8 colorectal, 3 hepatoma, 2 unknown primary, and 1 gastric cancer) were treated on a protocol examining the toxicity and efficacy in relieving jaundice of external beam radiation therapy (4500 cGy in 300 cGy fractions) combined with continuous hepatic arterial (15 patients) or peripheral venous (5 patients) fluorouracil infusion. Toxicity of this regimen consisted of anorexia with mild nausea and vomiting in 55% of patients and gastric ulceration (responsive to medical management) in 15% of patients. One patient exhibited transient grade 2 hepatic toxicity and one had asymptomatic grade 4 leukopenia. Of 14 patients treated without prior biliary drainage, 8 exhibited a decrease in bilirubin levels from a mean of 14.5 mg/dl to 1.5 mg/dl. Four of six patients with biliary drainage catheters at the start of treatment were able to have them removed without reobstruction. For the 8 responding patients among those who did not have cholangiocarcinomas, the median response duration was 5 months with a median survival from treatment of 6.5 months. For the 4 responding patients with cholangiocarcinoma, the median response duration was 16 months with a median survival from treatment of 20 months. All responders did not have a return of jaundice due to reobstruction of the major ducts (until death or to the present). All responders who have died did so due to tumor progression outside of the treated field except for one who died of unrelated causes. The mean number of proven or presumed episodes of cholangitis per patient was virtually identical in those without (1.8) and those with stents/tubes (1.4, p = 0.561). This regionally focused combined modality cytotoxic therapy was able to relieve obstruction in the majority of patients without excess morbidity (including a lack of any detectable increase in sepsis). Thus, it appears feasible to consider randomized studies of this cytotoxic approach versus standard mechanical drainage procedures to define the relative risks and benefits of each.
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PMID:Combination chemo-radiation therapy for jaundice due to focal malignant obstruction of the major bile ducts. 277 30

Upper abdominal symptoms after side-to-side choledochoduodenostomy (CDDY) may be attributed to stagnant bile, food and calculi pooling in the distal bile duct 'sump' with resultant biliary or pancreatic duct obstruction and sepsis. Endoscopic sphincterotomy (ES) provides a means of draining this sump. The aim of this study was to assess outcome following endoscopic retrograde choledochopancreatography (ERCP) and ES in patients with post-CDDY symptoms. Eight such patients (M: F = 1:7) underwent ERCP between September 1981 and March 1987. Their median age was 60 years (range: 37-72 years) and the median period since CDDY was 11 years (range: 1-28 years). The median follow-up after ERCP was 18 months (range: 14-94 months). Presenting symptoms comprised postprandial (one) or intermittent (seven) abdominal pain, cholangitis (three), pancreatitis (one) and jaundice (one). ERCP revealed bile duct abnormalities in four, consisting of filling defects alone (two), anastomotic narrowing with filling defects (one) and sclerosing cholangitis. ES was performed in seven, of whom three (all with filling defects at ERCP) remain asymptomatic and three are significantly improved. One had recurrent pancreatitis for which a sphincteroplasty and pancreatic duct septectomy was performed. ES was not performed in one because of technical difficulties (there being no subsequent improvement). It is concluded that, in patients with post-CDDY biliary symptoms, endoscopic sphincterotomy relieves the symptoms by either producing drainage of the sump at the distal bile duct, or dividing a dysfunctioning sphincter of Oddi.
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PMID:Treatment of postcholedochoduodenostomy symptoms. 281 37


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